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   Copyright (c) 2010, Dragan Babic
   
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    <title>Uni&ndash;Form</title>
    
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  <body>
<div id="login">
       
 <p id="inherited">
    
  <form action="<?=$current_module?>/authen"  method="post" class="uniForm">
            
      <fieldset>
        <h3>กรอกชื่อผู้ใช้และรหัสผ่าน</h3>
        
        <div class="ctrlHolder">
          <label for=""><em>*</em> Username</label>
          <input name="username" id="username" data-default-value="Placeholder text" size="35" maxlength="50" type="text" class="textInput required validateCallback my_code_callback"/>
          <p class="formHint">***</p>
        </div>
        
        <div class="ctrlHolder">
          <label for=""><em>*</em> Password</label>
          <input type="password" name="password" id="password" data-default-value="Placeholder text" size="35" maxlength="50" type="text" class="textInput validateEmail"/>
          <p class="formHint">***</p>
        </div>

        <div class="ctrlHolder">
          <p class="label">Privacy agreement</p>
          <ul class="blockLabels">
            <li><label for=""><input type="checkbox" name="agreement" class="required"> I have read the agreement</label></li>
          </ul>
        </div>

      </fieldset>
      
      <div class="buttonHolder">
        
       <button type="submit" class="primaryAction">Submit</button>
      </div>
    </p>
  </form></div>

    <div id="footer">
      <p>Supply Chain Management System. All Rights Reserved (C) 2012 Ubon bio ethanol Co., Ltd.</p>
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